Immediate reward bias in adolescent non-suicidal self-injury: Evidence from delay and probability discounting tasks

J Affect Disord. 2026 Mar 13:121626. doi: 10.1016/j.jad.2026.121626. Online ahead of print.

ABSTRACT

BACKGROUND: Non-suicidal self-injury (NSSI) constitutes a major public health concern among adolescents. Although impulsivity is a recognized risk factor, its specific role in value-based decision-making remains elusive. This study examined delay and probability discounting patterns in adolescents with NSSI compared to healthy controls across both gain and loss domains, identifying specific decision-making alterations associated with self-injurious behavior.

METHODS: Eighty-two adolescents (42 with NSSI absent of psychiatric comorbidities and 40 healthy controls) completed computerized delay and probability discounting tasks. Both tasks assessed decision-making using hypothetical monetary gains and losses. Discounting rates were quantified using area under the curve analyses.

RESULTS: For delay discounting, adolescents with NSSI discounted delayed gains more steeply than healthy controls, reflecting a stronger preference for immediate rewards. In contrast, group differences for delayed losses were non-significant and statistically equivalent to zero. Furthermore, no significant group differences emerged for either gains or losses in the probability discounting task.

LIMITATIONS: The cross-sectional design, the modest sample size, and the reliance on hypothetical rather than real-world monetary outcomes limit ecological validity and constrain causal inference.

CONCLUSIONS: These preliminary findings suggest that NSSI in adolescents may be associated with a preferential sensitivity to reward immediacy, rather than generalized deficits across all decision-making domains. This behavioral profile supports models conceptualizing NSSI as an emotion-regulation strategy prioritizing immediate relief over long-term benefits, highlighting delay tolerance as a potential target for intervention.

PMID:41833610 | DOI:10.1016/j.jad.2026.121626